The following slides identify the anatomical structures found on Panoramic Radiographs.

Panoramic Anatomy

In navigating through the slides, you should click on the left mouse button when you see the mouse holding an x-ray tubehead or you are done reading a slide. Hitting “Enter” or “Page Down” will also work. To go back to the previous slide, hit “backspace” or “page up”.

Types of Panoramic Images

Single Real Image

Double Real Image

Ghost Image

Single Real Image

Only one image results from a given anatomical structure. The structure is located between the rotation center and the film and the x-ray beam only passes through the structure one time. Most images seen on a panoramic film are of this type.

Double Real Image

Two images of a single object are seen on the film. Double real images are produced by structures located in the midline. The x-ray beam passes through these objects twice as the tubehead rotates around the patient. Structures that result in double real images are the hard and soft palates, the hyoid bone and the cervical spine.

Ghost ImageGhost images are formed by dense objects located between the tubehead and the rotation center. These ghost images usually result from external objects such as earrings, but they may be produced by dense anatomical structures such as the mandible. (For more information, see self-study module “Panoramic Technique”).

ghost image of earring(between lines)

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Panoramic AnatomyThe numbers on the diagram below and on the next slide (air spaces) correspond to the numbers on the key (slide 9).

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Air Spaces

Panoramic Anatomy Key 1. maxillary sinus 2. pterygomaxillary fissure 3. pterygoid plates 4. hamulus 5. zygomatic arch 6. articular eminence 7. zygomaticotemporal suture 8. zygomatic process 9. external auditory meatus10. mastoid process11. middle cranial fossa12. lateral border of the orbit13. infraorbital ridge14. infraorbital foramen15. infraorbital canal16. nasal fossa17. nasal septum18. anterior nasal spine19. inferior concha20. incisive foramen21. hard palate22. maxillary tuberosity23. condyle24. coronoid process

25. sigmoid notch26. medial sigmoid depression27. styloid process28. cervical vertebrae29. external oblique ridge30. mandibular canal31. mandibular foramen32. lingula33. mental foramen34. submandibular gland fossa35. internal oblique ridge36. mental fossa37. mental ridges38. genial tubercles39. hyoid bone40. tongue41. soft palate42. uvula43. posterior pharyngeal wall44. ear lobe45. glossopharyngeal air space46. nasopharyngeal air space47. palatoglossal air space

The following slides show anatomical structures seen on panoramic films. See what other structures you can identify that are not labeled. At the end of this presentation there are 11 test slides.

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R L

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Red arrows point to ghost image of hard palate

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R L

How old is this patient?a. 6-9 yearsb. 10-12 yearsc. 13-15 years

b. 10-12 years old

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2R L

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31

transverse foramen

atlas

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47 19

R L

What head positioning error is seen on this film?

The anterior teeth are positioned behind the notch in the bitestick (farther from the film), resulting in the widening of the anterior teeth (the maxillary central incisors are as wide as the molars).

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178 1

32

N

N = soft tissue of nose

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What head positioning error is seen on this film?

The head is tipped down too much, resulting in shortened mandibular incisors and a V-shaped mandible.

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E

LN

LN = calcified lymph nodeE = epiglottis

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What positioning error is seen on this film?The patient’s head is turned to the side. Note the width of the ramus on each side (The red arrows are the same length). Which direction was the patient’s head turned (left or right)?

The head was turned to the left, bringing that side closer to the film and decreasing the width of the ramus on that side. The green arrow points to the biteblock, centered on the contact between the right central and lateral incisors.

?

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? Identifies calcification, possibly in carotid or in lymph node

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E = epiglottis

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The black dots result from static electricity, caused by removing the film too quickly from the cassette or from the box of film (creates friction, which results in a static discharge).

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What causes the black dots identifed by the red arrow?What positioning error is seen on this film?

The chin is tipped up too much, giving a more squared off appearance to the mandible, creating a reverse smile and causing the hard palate to be superimposed on the roots of the maxillary teeth.

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G

G = ghost of right mandible

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27nose

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The lead apron was placed too high on the back of the patient’s neck.

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What caused the white (radiopaque) area indicated by the red arrow?

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12air cell

Air cell in zygomatic arch.

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ghost of mandible

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Note the relatively inferior location of the mandibular canal (30), providing plenty of room for the implant.

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Pattern on right side of film (patient’s left) caused by excessive oil on patient’s hair.

R L

red arrow identifies fracture

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Green arrow identifies “pseudo-fracture” caused by palatoglossal air space.Red arrows point to odontogenic keratocyst.

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Ghost images of earrings

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Ghost images of earrings

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Hearing aid (red arrow) with ghost (green arrow).

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Ghost image of metal used to restore left angle of mandible

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Ghost images of mandibles(dotted line outlines ghost of left ramus-angle overright side of mandible)

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Identify the anatomical structures on the following slides.

Slide # 1

A

B

C

D

E

FG

R L

ABCD

EFG

Cervical vertebraExternal oblique ridgeZygomatic processMaxillary sinus

Mandibular foramenLingula Zygomaticotemporal suture

A

D

E

F

G

H

I

J

K

Slide # 2

C

R B L

ABCDEF

GH IJK

Ear lobeExternal auditory meatusSubmandibular gland fossaNasal septumHard palateMental foramen

Hyoid boneMandibular canalPterygoid platesArticular eminencePterygomaxillary fissure

Slide # 3

A

E

D

BCR L

ABCDE

Palatoglossal air spaceMiddle cranial fossaLateral border of the orbitCondyle Mental fossa

Slide # 4

K

J

I

H

G

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E

D

CB

A

L

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ABCDEF

GH IJKL

Cervical vertebraZygomaticotemporal sutureZygomatic processNasal septumInferior conchaSoft tissue of nose

Hard palatePost. wall of maxillary sinusExternal auditory meatusPosterior pharyngeal wallMental foramenMental fossa

This concludes the section on Panoramic Anatomy. Additional self-study modules are available at: http://dent.osu.edu/radiology/resources.htm

If you have any questions, you may e-mail me at: jaynes.1@osu.edu

Robert M. Jaynes, DDS, MSDirector, Radiology GroupCollege of DentistryOhio State University